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A 32-week infant weighing 1.7 kg is born at a rural district general hospital. At 6 hours of age, the infant is on nasal continuous positive airway pressure (CPAP) but has a rising oxygen requirement exceeding 40%, respiratory acidosis and a chest X-ray consistent with respiratory distress syndrome (RDS). You decide the most appropriate management is to intubate and give surfactant. However, you know that this will require transfer of the infant if he remains ventilated following the procedure. You wonder if giving surfactant using a laryngeal mask airway (LMA) would be a suitable alternative which could reduce the need to intubate, ventilate and transfer similar patients in future.
Structured clinical question
In a 32-week infant with RDS (population), is surfactant administration by LMA (procedure) safe and effective at reducing the requirement for mechanical ventilation (outcome)?
A search was performed using MEDLINE, EMBASE and the Cochrane Register for Controlled Trials using the MeSH terms and free text: Laryngeal masks or laryngeal mask or supraglottic airway AND surface-active agents or surfactant AND infant OR premature OR preterm OR neonate. Initially, 87 articles were identified, 39 of which were duplicates, a further 38 studies were not relevant leaving 11 articles assessed in full, 5 relevant articles were included in final analysis (table 1). Authors of included studies were contacted if the outcome data sought was not included in the publication.
RDS caused by surfactant deficiency remains a significant cause of morbidity and mortality in the preterm infant.1 Strategies for surfactant replacement include early prophylactic following delivery room intubation or more recently selective where infants are stabilised on CPAP and then given surfactant selectively if they clinically go on to develop RDS. Historically, surfactant was given following intubation with an endotracheal tube (ETT) followed by a period of mechanical ventilation. …
NJS and JEO contributed equally.
Correction notice This article has been corrected since it was published Online First. The authors noticed that there is a key symbol missing from the clinical bottom lines. The passage of note is, ‘Use of LMA’s to administer surfactant is feasible in infants 1200g, reducing the need for intubation and mechanical ventilation (Grade B).’ It should read ‘Use of LMA’s to administer surfactant is feasible in infants ≥ 1200g, reducing the need for intubation and mechanical ventilation (Grade B).’
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.